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denniskwinn's version from 2015-04-25 16:10

Drug clinical uses

Question Answer
Fusion inhibitor clinical useIn patients with persistent viral replica in spite of antiretroviral therapy. Used in combination with other drugs
Interferons clinical useIFN alpha for chronic HBV or HCV, Kaposi’s sarcoma, IFN-B - MS. IFN gamma for NADPH oxidase deficiency
Reverse transcriptase clinical useHAART (Highly active anti retroviral therapy)
Foscarnet clinical useCMV retinitis in immunocompromised patients when ganciclovir fails; and for acyclovir-resistant HSV
Ganciclovir clinical useCMV, especially in immunocompromised patients.
Acyclovir clinical useHSV, VZV, EBV - used for HSV induced mucocutaneous and genital lesions as well as for encephalitis. Prophylaxis in immunocompromised patients. For herpes zoster, use a related agent, famciclovir. No effect on latent forms of HSV and VZV.
Ribavirin clinical useRSV, chronic hepatitis C
Penicillin clinical use1. Bactericidal for gram + cocci, rods, gram - cocci and spirochetes
Penicillinase resistant penicillin clinical usesS. Aureus (except MRSA; resistant because of altered penicillin-binding protein target site)
Aminopenicillin clinical use1. HELPS ( H. Flu, E. Coli, Listeria monocygenes, Proteus mirabilis, Salmonella, enterococci)
Antipseudomonals clinical usePseudomonas spp. And gram-negative rods - susceptible penicillinase; use with clavulanic acid (beta-lactamase inhibitor)
Aztreonam clinical use Gram - rods, Klebsiella, Pseudomonas, Serratia, No activity against gram+ or anaerobes. For penicillin allergic patients and those with renal insufficiency who cannot lerate aminoglycosides
Imipenem clinical useGram+cocci, gram - rods, anaerobes. Drug of choice for enterobacter but significant side effects limit life-threatening infections Meropenem has reduced risk
Vancomycin clinical use Serious gram+ multidrug resistant organisms (S. Aureus, C.diff)
Aminoglycosides clinical useSevere gram - rod infections, synergystic with beta-lactams - Neomycin for bowel surgery - ineffective agains anaerobes
Demeclocycline clinical useADH antagonist - SIADH tx
Tetracycline clinical usesVACUUM THe BedRoom (Vibrio cholerae, Acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Tularemia, H.pylori, Borrelia burgdorfia (lyme), Rickettsia
Macrolides clinical useURIs, pneumonias, STDs - gram + cocci (strepcoccal infections in patients allergic penicillin), mycoplasma, legionella, chlamydia, neisseria
Chloramphenicol clinical useMeningitis (H. Flu, N. Meningitidis, Strep pneumo) - conservative use due xicities
Clindamycin clinical useTreat anaerobes above the diaphragm - (Bacteroides fragilis, Clostridium perfringens)
Sulfonamides clinical useGram +, Gram - , Nocardia, Chlamydia, Triple sulfas or SMX for simple UTI
Trimethoprim clinical usein combination with sulfonamides causing sequential block of folate synthesis - combination used for recurrent UTI, shigella, salmonella, pneumocystis jiroveci
Fluoroquinolones clinical useGram - rods of urinary and GI tracts (including pseudomonas), Neisseria, some gram +
Metronidazole clinical useTreats Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, anaerobes (bacteroides, clostridium) - Used with bismuth and amoxicillin (or tetracycline) for triple therapy against H.pylori
Polymyxin clinical useResistant gram - infections
Isoniazid clinical useMycobacterium tuberculosis - solo prophylaxis
Rifampin clinical use Mycobacterium tuberculosis - delays resistance dapsone when used for leprosy. Used for meningococcal prophylaxis and chemo prophylaxis in contacts of children with H. Flu B. - rapid resistance if monotherapy
Amphotericin clinical useused for wide spectrum of systemic mycoses (Crypcoccus, blasmyces, coccidioides, aspergillus, Hisplasma, Candida, Mucor) . Intrathecally for fungal meningitis; does not cross blood brain barrier
Nystatin clinical use“Swish and swallow” for oral candidiasis (thrush); topical for diaper rash or vaginal candidiasis
First generation cephalosporins names and use1. Cefazolin, cephalexin 2. Gram + cocci, proteus mirabilis, e. Coli, klebsiella pneumoniae (PEeK)
Second generation cephalosporins names and uses1. Cefoxitin, Cefacr, Cefuroxime 2. HEN PEcKS ( Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens
Third generation cephalosporins names and uses1. Ceftriaxone, Cefotaxime, Ceftazidime 2. Serious gram - infections resistant other beta lactams - meningitis 3. Most penetrate the BBB
4th generation cephalosporins name and usesCefepime - increased activity vs Pseudomonas and gram + organisms
Azole clinical useSystemic mycoses, Fluconazole for crypcoccal meningitis in AIDs patients (crosses BBB) and candidal infections of all types (i.e. Yeast infection) . Keconazole for blasmyces, coccidioides, hisplasma, candida albicans, hypercortisolism, clotrimazole and miconazole for pical fungal infections
Flucytosine clinical useUsed in systemic fungal infections (candida, cryp) in combination with amphotericin B
Caspofungin clinical useinvasive aspergillosis
Terbinafine clinical useused treat dermaphyses (especially onychomycosis)
Griseofulvin clinical useOral treatment of superficial infections; inhibits growth of dermaphytes (tinea ringworm)
Amantadine clinical useprophylaxis and tx for influenza A; parkinson’s disease
Zanamivir, Oseltavir clinical useBoth influenza A and B

Drug Toxicities

Question Answer
Fusion inhibitor toxicityhypersensitivity, reactions at subcutaneous injection site. Increased risk of bacterial pneumonia
Interferon toxicityNeutropenia
Penicillin toxicityHypersensitivity reactions, hemolytic anemia
Penicillinase resistant penicillins toxicityhypersensiticity rxns; methicillin - interstitial nephritis
Aminopenicillin toxicityHypersensitivity reactions: ampicillin rash; pseudomembranous colitis
Antipseudomonals toxicityhypersensitivity reactions
Aztreonam toxicityUsually nonxic, occasional GI upset - no cross sensitivity with penicillins or cephlosporins
Imipenem toxicityGI distress, skin rash, CNS toxicity (seizures) at high plasma levels
Vancomycin toxicityNephrotoxicity, Otoxicity, Thrombophlebitis, diffuse flushing - “red man syndrome” (can prevent by pretreatment antihistamines and slow infusion rate) well lerated in general
Cephalosporin xicitiesHypersensitivity reactions - cross hypersensitivity with penicillins occur in 5-10% of patients. Increases nephrotoxicity of aminoglycosides; disulfram like reaction with ethanol
Aminoglycosides toxicityNephrotoxicity (especially when used with cephalosporins), Otoxicity (especially when used with loop diuretics) Teragen
Tetracycline toxicityGI distress, discoloration of teeth and inhibition of bone growth in children, phosensitvitiy - contraindicated in pregnancy
Macrolide toxicityProlonged QT (esp erythro), GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rashes, Increases serum concentration of theophyllines, oral anticoagulants
Clindamycin toxicityPseudomembranous colitis (C.diff overgrowth) , fever, diarrhea
Sulfonamides toxicityHypersensitivity, hemolysis if G6PD deficient, nephrotoxicity, phosensitivity, kernicterus in infants, displace other drugs from albumin (warfarin)
Trimethoprim toxicityMegaloblastic anemia, leukopenia, granulocypenia (may alleviate with supplemental folic acid)
Fluoroquinolones toxicityGI upset, superinfection, skin rashes, headache, dizziness. Contraindicated in pregnant women and children b/c of potential cartilage damage. Tendonitis and tendon rupture in adults, leg cramps and myalgias in kids
Metronidazole toxicity Disulfram like reaction with alcohol; headache, metallic taste
Polymyxin toxicityNeurotoxicity, acute renal tubular necrosis
Isoniazid toxicityNeurotoxicity, hepatoxicity, pyridoxine (B6) can prevent neurotoxicity
Rifampin toxicityMinor hepatoxicity and drug interactions (increased p450) - orange body fluids (nonhazardous)
Mechanism of penicillin/cephalosporin toxicityBeta-lactamase cleavage of beta-lactam ring or altered PBP in caes of MRSA or penicillin resistant S. Pneumoniae
Amphotericin toxicityFever/chills (shake and bake), hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis (amphoterrible). Hydration reduces nephrotoxicity, liposomal amphotericin reduces toxicity
Azole toxicityHormone synthesis inhibition (gynecomastia), liver dysfunction (inhibits cychrome p-450), fever, chills
Flucysine toxicityNausea, vomiting, diarrheas, bone marrow suppression
Caspofungin toxicityGI upset, flushing
Griseofulvin toxicityTeragenic, carcinogenic, confusion, headaches, increased p450 and warfarin metabolism
Amantidine toxicityataxia, dizziness, slurred speech
Ribavirin toxicityHemolytic anemia, severe teragen
Acyclovir toxicityGenerally well lerated
Ganciclovir toxicityLeukopenia, neutropeniam thrombocypenia, renal toxicity. More xic host enzymes than acyclovir
Foscarnet toxicityNephrotoxicity
HIV protease toxicityGI inlerance (nausea, diarrhea), hyperglycemia, lipodyxtrophy, thrombocypenia (indinavir)
Reverse transcriptase inhibitors toxicity Bone marrow suppression (neurpenia, anemia), peripheral neuropathy, lactic acidosis (nucleosides), rash (non-nucleosides), megaloblastic anemia(ZDV) - - GM-CSF and erythropoietin can be used reduce bone marrow suppression
Chloramphenicol xicitiesAnemia (dose dependent), aplastic anemia, gray baby syndrome (in premature infants because they lack liver UDP-glucuronyl transferase)= Section
Sulfa drug allergies patients who do not lerate sulfa dugs should not be given sulfonamides or other sulfa drugs, such as sulfasalazine, sulfonylureas, thiazide diuretics, acetazolamide or furosemide